Changing times: why direct-entry midwives are re-training as Health Visitors and how this affects their professional identity

This document is the Accepted Manuscript version of the following article: Annabel Jay, Val thurtle, and Radica Hardyal, 'Changing times: why direct-entry midwives are retraining as health visitors and how this affects their professional identity', MIDIRS Midwifery Digest, Vol. 26 (2): 171-177, January 2016.In the wake of the Health Visitor Implementation Plan (HVIP) one county in Southern England noted an increasing number of direct-entry midwives leaving local maternity units to re-train as health visitors. The implications of this for workforce planning in both professions sparked an investigation into this phenomenon. The study aimed to explore reasons for re-training and how such midwives/health visitors viewed their professional identity. An online questionnaire was sent to all 37 midwives who had undergone health visitor training at the local University since the start of the HVIP in 2011. This was followed by a focus group and individual interviews. Full ethical approval was granted. Reasons for leaving midwifery centred on the over-stretched working environment leading to difficulty in maintaining client safety and unsupportive management systems. Other reasons included difficulty juggling family life with shift work and the lack of opportunities for career development. Specific reasons for becoming a health visitor included a desire to provide better continuity of care for clients within a safer working environment. Findings support earlier works on attrition from midwifery, however, this is the only study to date which has focused on direct-entry midwives moving to health visiting and suggests that urgent action is required to improve staffing levels and support if the midwifery profession is to retain this body of conscientious and highly-motivated professionals.Non peer reviewedFinal Accepted Versio

Practice standards for the newborn and infant physical examination: a national survey

This article is distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.This is a summary of an article previously published in another journal. Full reference: Rogers, C., Jay, A,. Yearley, C., Beeton, K. (2015). National survey of current practice standards for the newborn and infant physical examination. British Journal of Midwifery. 23 (12): 862-73Non peer reviewedFinal Accepted Versio

Education provision for the newborn physical examination as a postregistration module: National survey

This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Midwifery, February 2017, Vol. 25, No. 2, Copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see https://www.research.herts.ac.uk/admin/files/11149919/bjom.2017.25.2.88.pdfAims This study aimed to assess the scope of newborn infant physical examination (NIPE) education in post-registration midwifery education, determine the structure and requirements for midwives undertaking NIPE training, and explore similarities and differences in pre- and post-registration preparation requirements. Methods In early 2015, all lead midwives for education in the UK were sent a link to an online questionnaire to assess the scope and practice of NIPE education across all midwifery curricula. This is the second of a two-part report, focusing on post-registration education; part A examined the education provision for the inclusion of NIPE in the midwifery curriculum. Findings NIPE education for midwives is popular and is well established in the post-registration curriculum. Variations exist in the length, content, assessment, levels of study and credits awarded for post-registration NIPE modules. This lack of standardisation raises questions about quality assurance. Conclusion The variation in module length has implications for commissioners and self-funding students, as longer NIPE modules are more costly. There is a strong argument for a standardised NIPE programme across the UK and for providers of maternity services to fully utilise midwives who have been trained in NIPE to avoid them becoming de-skilled.Peer reviewe

In labor or in limbo? : The experiences of women undergoing induction of labor in hospital: findings of a qualitative study

This is the peer reviewed version of the following article: Annabel Jay, Hilary Thomas, and Fiona Brooks, ‘In labor or in limbo? The experiences of women undergoing induction in labor in hospital: Findings of a qualitative study’, Birth: Issues in Perinatal Care, September 2017. Under embargo. Embargo end date: 17 September 2018. This article has been published in final form at DOI: 10.1111/birt.12310. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Background: Induction of labor currently accounts for around 25% of all births in high-resource countries, yet despite much research into medical aspects, little is known about how women experience this process. This study aimed to explore in depth the induction experience of primiparous women. Methods: A qualitative study was undertaken, using a sample of 21 first-time mothers from a maternity unit in the south of England. Semi-structured interviews were conducted in women's homes between 3 and 6 weeks postnatally. Data were recorded, transcribed, and analyzed thematically. Results: Women awaiting induction on the prenatal ward appeared to occupy a liminal state between pregnancy and labor. Differences were noted between women's and midwives’ notions of what constituted “being in labor” and the ward lacked the flexibility to provide individualized care for women in early labor. Unexpected delays in the induction process were common and were a source of anxiety, as was separation from partners at night. Women were not always clear about their plan of care, which added to their anxiety. Conclusions: Conceptualizing induction as a liminal state may enhance understanding of women's feelings and promote a more woman-centered approach to care. Thorough preparation for induction, including an explanation of possible delays is fundamental to enabling women to form realistic expectations. Care providers need to consider whether women undergoing induction are receiving adequate support, analgesia, and comfort aids conducive to the promotion of physiological labor and the reduction of anxiety.Peer reviewedFinal Accepted Versio

Real world study of sacituzumab govitecan in metastatic triple-negative breast cancer in the United Kingdom

Background: Treatment options for pre-treated patients with metastatic triple-negative breast cancer (mTNBC) remain limited. This is the first study to assess the real-world safety and efficacy of sacituzumab govitecan (SG) in the UK. Methods: Data was retrospectively collected from 16 tertiary UK cancer centres. Pts had a diagnosis of mTNBC, received at least two prior lines of treatment (with at least one being in the metastatic setting) and received at least one dose of SG. Results: 132 pts were included. Median age was 56 years (28–91). All patients were ECOG performance status (PS) 0-3 (PS0; 39, PS1; 76, PS2; 16, PS3;1). 75% (99/132) of pts had visceral metastases including 18% (24/132) of pts with CNS disease. Median PFS (mPFS) was 5.2 months (95% CI 4.5–6.6) with a median OS (mOS) of 8.7 months (95% CI 6.8-NA). The most common adverse events (AEs) were fatigue (all grade; 82%, G3/4; 14%), neutropenia (all grade; 55%, G3/4; 29%), diarrhoea (all grade; 58%, G3/4, 15%), and nausea (all grade; 38%, G3/4; 3%). SG dose reduction was required in 54% of pts. Conclusion: This study supports significant anti-tumour activity in heavily pre-treated pts with mTNBC. Toxicity data aligns with clinical trial experience

Management of latent Mycobacterium tuberculosis infection:WHO guidelines for low tuberculosis burden countries

ABSTRACT Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing an

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

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An article describing a programme of involving service-users in the selection of students on pre-registration midwifery programmes.Non peer reviewe